Headaches can root from hundreds of health conditions. Fortunately, dreadful diseases like brain tumor, blood-vessel abnormalities and increased pressure inside the head due to poor fluid drainageetc are rare.Benign conditions like tension headache, migraine and so on are much more common because many people are susceptible to emotional stress. Moreover, in many psychiatric disorders, including anxiety and depressive disorders, headache is frequently a prominent symptom.

But due to lack of knowledge, people tend to be quite alarmed by this common ailment.  No sooner have they landed in hospital, and before the doctor has even examined them properly, that patients and their well-wishers usually want to opt for expensive and sophisticated investigations like CT Scans, MRI, blood cholesterol level checkup, etc. The doctor at times runs the risk of losing them altogether if he tries to explain that such tests are not necessary. Obviously, most of the test results will be negative, which can be frustrating for both the patient and the physician. Physicians not well versed in psychological medicine may attempt to reassure such patients by telling them that they don’t have any disease, but such reassurances may have the opposite effect: they may increase the patients’ anxiety and the consultation may even escalate into a disagreement about whether the pain is imagined or real.

Thus, a lot of people unnecessarily keep on suffering physically, mentally, socially and financially. A few people with headaches reach mental health professionals only after having traversed a long and winding road, often after exhausting all other resources.

What are tension-headaches?

Emotional stress is often associated with  prolonged contraction of the head and neck muscles. This may constrict the blood vessels and result in decreased blood-flow. Thus there tends to be a dull, aching pain, which sometimes feels like a tightening band. This often begins below the occipital region and may spread over the head. The scalp may be tender to the touch. The headache is usually on both sides and not associated with nausea and vomiting, unlike with migraine. The onset is often towards the end of the workday or in the early evening, possibly after  a stressful day at work, when one tries to relax.

Tension-headaches are frequently (80 percent of the time) associated with anxiety and depre-ssion. Tense, high-strung, competitive type A personalities are especially prone to the disorder.

The diagnosis of tension-headaches is purely based on careful history-taking and clinical examination and seldom requires laboratory investigations.

Treatment of tension-headaches:

In the initial stages, patients may be treated with anti-anxiety agents, muscles relaxants and with massage or heat application to the head and neck. Antidepressants may be prescribed when underlying depression or anxiety disorder is present.

In the absence of depression or anxiety disorders, non-pharmacological interventions, like psychotherapy, may also be a treatment of choice for people chronically afflicted by tension-headaches. Learning to avoid or better cope with tension is the most effective long-term management approach. Relaxation exercises, meditations or changes in a hectic lifestyle may also provide symptomatic relief for some patients.

To put it simply, for solving tension-headaches, a mental health professional should be the first expert to seek help from.

Shakya is an Associate Professor & Head of the Dept of Psychiatry, Patan Academy of Health Sciences